March 7, 2012

It's More Than a Bump to the Head

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Joseph V. Madia, MD By:

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Brain injuries mean more challenges followed a concussion

(dailyRx News) Bumps and bruises are as much a part of a childhood as sleepovers and mud pies - but that doesn't mean that bumps to the head shouldn't be taken seriously.

Mild traumatic brain injuries, or TBIs, aren't uncommon among children, with more than a half million kids under age 15 experiencing TBIs each year that require hospital care, according to background information in a new study.

"Children with mild head injuries must be extra careful following concussions."

Lead author Keith Owen Yeates, Ph.D., of Nationwide Children's Hospital and The Ohio State University, Columbus, and colleagues compared two groups of children, aged 8 to 15, who experienced a concussion.

One group included 186 children who had mild traumatic brain injury, and the other included 99 children with orthopedic injuries. They looked at statistically measurable changes in postconcussive symptoms and in cognitive function one year after each child was injured.

The symptoms they recorded included headaches, fatigue, memory and difficulty concentrating or staying on task.

The children who had mild TBI also had more symptoms than the children who had orthopedic injuries. In particular, the children with mild TBI who had abnormal brain images or who had lost consciousness had the highest increase in symptoms.

Those children who had increases in their symptoms of headache and fatigue were also at a higher risk for receiving intervention at school three months after their injury.

"These results extend previous findings by showing that many individual children with mild TBI show substantial and persistent increases in postconcussive symptoms relative to their preinjury functioning," the researchers wrote.

"These results indicate that persistent postconcussive symptoms have functional consequences that are likely to reflect impairment in children's daily functioning," they wrote.

They added that health providers must be able to identify children who have mild TBI so they can treat them effectively followed a concussion.

The editor of the Archives of Pediatrics & Adolescent Medicine, the JAMA journal in which the study appears, wrote an accompanying editorial regarding the importance that needs to be paid to concussions in children.

"The overall message emerging from this research is that the group of injuries classified as 'mild TBI,' including sports-related concussions, should not necessarily be treated as minor injuries, which quickly resolve," wrote editor Frederick Rivara, M.D., M.P.H., of the University of Washington, Seattle.

While acknowledging the obvious differences between getting a concussion while playing football and a concussion a soldier might get from a bomb blast during combat, Rivara said there is crossover in terms of what both concussed patients would be likely to experience.

He also acknowledged the challenges of continuing to promote physical activity and sports as a way to combat obesity while encouraging people to take sports-related concussions seriously.

"How do we promote the engagement of youth in these sports and, at the same time, ensure that they are safe from concussion?" he asked.

The study appeared online ahead of print March 5, and the research was supported by grants from the National Institutes of Health.
 

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Reviewed by: 
Joseph V. Madia, MD
Review Date: 
March 7, 2012

Last Updated:
March 7, 2012